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Background Decision-making about palliative care for metastatic colorectal cancer (mCRC) consists of many different treatment-related decisions, and there generally is no best treatment option. Decision support systems (DSS), e.g., prognostic calculators, can aid oncologists’ decision-making. DSS that contain features tailored to the needs of oncologists are more likely to be implemented in clinical practice. Therefore, our aim is to inventory colorectal cancer specialists’ unmet decision support needs. Methods We asked oncologists from the Dutch colorectal cancer group (DCCG), to participate in an online inventory questionnaire on their unmet decision support needs. To get more in-depth insight in required features of the DSS they need, we also conducted semi-structured telephone interviews. Results Forty-one oncologists started the inventory questionnaire, and 27 of them completed all items. Of all respondents, 18 were surgeons (44%), 22 were medical oncologists (54%), and 28 (68%) had more than 10 years of experience treating mCRC. In both the inventory questionnaire and interviews, respondents expressed a need for an overarching DSS incorporating multiple treatment options, and presenting both the treatment benefits and harms. Respondents found it relevant for other outcomes, such as cost-effectiveness of treatment or quality of life, to be incorporated in DSS. There was also a wish for DSS incorporating an up-to-date “personalized” overview of the ongoing trials for which a specific patient is eligible. Conclusions Experienced oncologists indicate that their treatment advice is currently almost solely based on the available clinical guidelines. They experience a lack of good quality DSS to help them personalize their treatment advice. New tools integrating multiple treatment options and providing a broad range of clinically relevant outcomes are urgently needed to stimulate and safeguard more personalized treatment decision-making.

SY:48歳女.全身倦怠感を主訴とした.頻尿, 残尿感があり, 超音波検査で両側水腎症を認めたため入院した.血液検査で軽度の貧血と腎不全を認め, 尿検査で血尿を認めた.膀胱鏡検査で三角部に腫瘍を認めたため, 腫瘍生検を行った.又, 腹部CT, 胸部CT.骨シンチにより全身への転移を認めた.生検による病理所見より印環細胞癌と診断した.入院当初は膀胱への転移を疑い, 原発巣検索のため他科的検査を行ったが異常は見られず, 膀胱原発と診断した.全身に転移しており, 疼痛コントロールのみで退院した.良好な疼痛コントロールを得たが, 診断の約5ヵ月後死亡した.病理解剖の結果, 膀胱原発で全身に転移した印環細胞癌を確認した, We report a case of signet-ring cell carcinoma of the urinary bladder. A 48-year-old female was hospitalized because of general fatigue, pollakiuria and residual sensation. Renal ultrasonography disclosed bilateral hydronephrosis. The serum level of cretinine was 3.1 mg/dl, and we diagnosed the patient with post-renal failure. Cystoscopic examinations revealed non-papillary sessile tumors in the trigone. Histopathological findings of the biopsy specimen demonstrated signet-ring cell carcinoma. There was no evidence indicating bladder metastasis from the cancer in other organs. The patient died of cachexia 5 months after the diagnosis. She was autopsied, and the diagnosis of signet-ring cell carcinoma of the urinary bladder with metastases in various organs was confirmed. This disease is extremely rare and has a poor prognosis. We review the previous cases reported in the literature.